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| Workshop C-2: Improving communication with diverse populations: implications for qualityQuality, Safety and Hospital Care for Latino Children: Addressing Parent and Provider Communication ChallengesIt is widely understood that problems in communication contribute to problems with the quality and safety of health care provided to Limited English Proficiency persons. Yet, few studies have examined this relationship for children requiring hospital services or have sought to understand differences in perspectives and recommended solutions set forth by LEP parents, providers and hospital leaders. In addition, while organizational self-assessments have been developed, few surveys of LEP parents to identify communication issues and assess quality and safety of care have been designed. Such tools can contribute to hospital efforts to improve performance in this important area and provide LEP parents a voice regarding the quality of hospital care for their children. In this presentation we will describe qualitative and quantitative methods used to understand and assess the relationship between communication and the quality and safety of health care provided to Latino children requiring hospital services from the perspective of LEP parents, hospital care providers and hospital quality leaders. We will review methods, challenges, findings and outcomes from:
Participants can receive example recruitment and focus group protocols used in this study as well as copy of the draft survey module. Participants will be asked to comment on study findings and assist in the specification of ongoing research and action needed in this important area of health care quality for children from Limited English Proficiency homes. Dr. Bethell has led the design and evaluation of focus groups with Limited English Proficiency persons and in the design and implementation of parent surveys on health care quality since 1993. She recently completed a Commonwealth Fund project on evaluating the application of consumer/patient reported quality surveys for culturally diverse populations and a project assessing parent issues and needs for quality information regarding hospital care for children. She has served as principle investigator on the development and testing of parent quality survey tools that have now been extensively administered in Spanish and several other languages nationally, in states and in health care plans and pediatric practices. She is currently engaged in further evaluating the validity of the current translation and administration methods of these tools for people of Hispanic ethnicity.
Improving Patient Safety for Limited English Proficient (LEP) Patients through Improved Access to Linguistic ServicesMedical errors related to patient-provider communication failures occur frequently among minority Americans, and many of these events are preventable. Safe, high quality care requires meaningful involvement of the patient and his/her health care team, with a shared understanding between patient and provider. Funded in part by the Commonwealth Fund, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is engaged in a project designed to better understand the epidemiology of patient-provider communication failures due to language barriers and to implement intensive quality improvement interventions for LEP patients in hospitals. The key research questions for this study include: 1) Do LEP patients have a higher risk and/or different patterns of adverse events than English speaking patients? 2) Do LEP patients who were seen by monolingual providers have a higher risk and/or different patterns of adverse events than those seen by bilingual providers? 3) Do LEP patients who did not require interpreters have a higher risk and/or different patterns of adverse events than those who were provided interpreters? 4) Do LEP patients who received ad hoc interpreters have a higher risk and/or different patterns of adverse events than those who were provided professional interpreters? The project aims to demonstrate through root cause analyses, that improved access to linguistic services (increased availability and utilization of interpretative services) and improved quality of linguistic services (increased availability and utilization of trained medical interpreters) can reduce adverse events and near misses and improve patient safety for patients with LEP. The major steps of the project include: 1) selecting a group of 10-15 hospitals that currently have patient safety incident reporting systems. These hospitals will collect retrospective data pertaining to adverse events in limited English proficient patients covering a six month period as well as prospective data on adverse events in limited English proficient patients for a 10 month period, 2) development of a Patient Safety Data Framework, which will include the key data elements that are required to analyze incident reports for language and communication related causative and contributive factors, 3) refinement of the JCAHO’s Patient Safety Taxonomy that will be used to classify incidents reported through different hospital reporting systems so that incidents pertaining to limited English proficient patients can be compared across hospitals, and 4) identifying preventive strategies that are more broadly applicable. This workshop will address the impact of LEP status on the occurrence of adverse events for patients in hospitals. Specifically, it will qualitatively examine and identify the language-related causative and contributive factors associated with adverse events in this patient population using the Joint Commission’s Patient Safety Event Taxonomy and root cause analysis methodology. Andrew Chang, JD, MPH is Director for the Center for Patient Safety Research at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). His professional efforts are focused on improving health care quality and patient safety through defining and applying evidence-based strategies in health care. In his current role, he is responsible for designing, implementing and evaluating patient safety improvement research initiatives for the Joint Commission. Mr. Chang has also served with the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) to develop key policy and legislative issues relating to the rulemaking of federal health regulations that affect women, children, and minorities. As an attorney, he has researched health law and practiced in personal injury and product liability. He received his undergraduate degree from the University of California, Los Angeles and a law degree from the University of California, Hastings College of the Law. Mr. Chang also holds a Master of Public Health degree from the Harvard School of Public Health, where his focus was law and public health. He is currently the Principal Investigator of patient safety grant awards from the Agency for Healthcare Research and Quality (AHRQ) and The Commonwealth Fund. He has been the recipient of the U.S. Health and Human Services Distinguished Service Award for his contribution in public health. Chandrika Divi, MPH is an Associate Project Director in the Center for Patient Safety at the Joint Commission on Accreditation of healthcare Organizations. She is the project manager for the study Understanding Adverse Events in Minority Patients with Limited English Proficiency funded by the Commonwealth Fund. Ms. Divi has developed proposals and worked on projects related to patient safety, health care quality and emergency preparedness. She earned an MPH from Boston University in International Health and Health Services, and a BSc in biology from the University of Ottawa, Canada.
Improving Patient Safety Through Informed Consent in Limited English Proficiency and Low Literacy PopulationsFully informed consent to medical interventions is critical not only to ensure meaningful patient participation in decision-making, but also to act as a safeguard against potential adverse outcomes or medical errors. Asking patients to recount what they consented to is one strategy ensuring that they understand information about the risks, benefits, alternatives, and reason for the medical treatment they receive. Although the practice of asking patients to repeat back such information was recently endorsed by the National Quality Forum (NQF) as a national voluntary consensus standard in its report, Safe Practices for Better Healthcare, its use is not yet widespread. Implementing this practice is especially challenging for providers serving low-literacy and limited English Proficiency (LEP) populations, yet these are precisely the patients at greatest risk of being harmed or inadequately informed. With a grant from The Commonwealth Fund, NQF undertook a project to investigate the barriers to, and strategies for, successfully using the NQF-endorsed Safe Practice 10: “ask each patient or legal surrogate to recount what he or she has been told during the informed consent discussion.” Safe Practice 10 was developed following an extensive process of evidence review, analysis by patient safety experts, and endorsement by a wide range of stakeholders under NQF’s formal Consensus Development Process. It established a national standard for ensuring adequate comprehension during the informed consent process, and the practice has great promise for addressing the needs of patients who face communication challenges in the medical system, such as LEP and low health literacy groups. The project focused on patients undergoing non-investigational, invasive procedures and evaluated the informed consent process for all patients, with a special emphasis on how Safe Practice 10 could be used to meet the additional needs of LEP and low literacy populations. The major steps in this project were to: 1) conduct focused assessments of a few hospitals that had systematically implemented Safe Practice 10 for a specific department or throughout the facility, in order to evaluate how the practice was used and what the successes and challenges were, 2) hold structured interviews with healthcare providers and administrators whose facilities were not using the practice, to identify the barriers and opportunities for implementing Safe Practice 10 at their facility, and 3) develop a user’s guide to assist providers to implement the practice. A workshop was held on September 10, 2004 to bring together healthcare providers and other experts to discuss these findings and to share their perspectives on how to facilitate broader adoption of the Safe Practice 10 on a national level. The workshop participants also made recommendations on how a user’s guide for providers should be designed and what information it should include in order to provide meaningful assistance to providers seeking to adopt the practice. This presentation will overview findings from the project and the workshop discussions. It will identify what the key challenges were in getting providers to use a well-established practice that could improve patient safety and communication, especially for vulnerable populations, and it will describe the models for success used at hospitals that had systematically implemented the practice. Additionally, it will seek audience feedback about the perceived challenges and opportunities in implementing NQF-endorsed Safe Practice 10 at their facilities and request input on what information and tools would be valuable for providers, interpreters, and others who may benefit from the Safe Practice 10 user’s guide. Ms. Wu is a Program Director for the National Quality Forum, an organization that establishes voluntary consensus standards for healthcare quality measurement and reporting. She leads all NQF work in minority healthcare quality, including its current projects on improving patient safety through informed consent and improving medication adherence for communication-challenged groups such as those with limited English proficiency or low health literacy. Ms. Wu led the work on and was lead author of the NQF report, Measuring and Reporting Healthcare Quality for Minority Populations. She has served on expert committees and presented on minority healthcare quality issues for various national groups, including the U.S. Office of Minority Health, Agency for Healthcare Research and Quality, American Osteopathic Association, and Institute of Medicine. She earned a MSc from the University of Virginia in health evaluation sciences, specializing in health services research and outcomes evaluation, and a BA from the University of Virginia in philosophy with a minor in biomedical ethics.
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National Conference is presented by State University of New York Downstate Medical Center, Resources for Cross Cultural Health Care, Arthur Ashe Institute for Urban Health, US Department of Health and Human Services, Joint Commission on Accreditation of Healthcare Organizations |
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| As with the rest of Diversity Rx, this section
is a work in progress and we welcome information on other efforts, programs,
and reports that will expand upon the information offered here. Please
let us know if you have other examples to include here. |
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Diversity Rx is sponsored by: |
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